CMS Price Transparency Data

Speech therapy (language evaluation)

Facility: St Clair Hospital

Billing Code: 92507 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 92507
Insurance Median: $81
Cash Discount Price: $48
vs. Medicare Baseline: 1.06x Medicare

The contracted insurance negotiated median rate for a Speech therapy (language evaluation) at St Clair Hospital is $81. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $76.15, this hospital’s rate is 1.06x the Medicare baseline. Located in 1000 Bower Hill Road, Pittsburgh, PA.

Cash / Self-Pay

$48

Average discount available for prompt cash payment at this facility.

Insurance Median

$81

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$76.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $76.15 (100%)

Cash / Self-Pay: $48 (63%)

Insurance Median: $81 (106%)

Cash: $48 (63% of Medicare)

Ins. Median: $81 (106% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $76.15 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
UnitedHealthcare	$23 - $81	30%
Aetna	$25 - $197	33%
Amerihealth	$25 - $73	33%
Geisinger	$25 - $76	33%
Health Partners	$25 - $77	33%
Highmark	$25 - $148	33%
Pa Health And Wellness	$25 - $76	33%
Upmc	$34 - $123	45%
Humana	$73	96%
Cigna	$76 - $125	100%
The Health Plan	$77 - $176	101%
Lantern	$158	207%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $48.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 92507.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Clair Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 92507.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.